Iatrogenic iron overload caused by iron isomaltoside treatment: A case report

RATIONALE: Iron-deficiency anemia is commonly treated with intravenous (IV) iron supplementation; however, excessive use can lead to iron overload and subsequent organ damage. Iron isomaltoside, a newer IV iron formulation, may also contribute to iron overload, necessitating vigilant monitoring by clinicians. This report presents a case of iatrogenic iron overload induced by iron isomaltoside therapy. To the best of our knowledge, this is the first documented case of iron overload associated with iron isomaltoside. PATIENT CONCERNS: A 65-year-old female patient with systemic lupus erythematosus developed iron overload after receiving 7500 mg of iron isomaltoside over 5 weeks. Laboratory results showed significantly elevated serum ferritin levels (4336.47 ng/mL), and magnetic resonance imaging confirmed iron deposition in both the liver and spleen. DIAGNOSES: Laboratory tests and magnetic resonance imaging confirmed iron overload. INTERVENTIONS: The patient was treated with deferasirox for iron chelation. OUTCOMES: After 8 months of iron removal treatment, the patient's serum ferritin level gradually decreased to 1236.2 ng/mL, accompanied by improvements in hyperpigmentation and fatigue. No severe adverse events or gastrointestinal symptoms were observed during deferasirox administration, and kidney function remained stable throughout. LESSONS: This case highlights the risk of iron overload associated with unmonitored IV iron supplementation. Monitoring iron levels is crucial to prevent complications, particularly in high-risk patients. Iatrogenic iron overload can arise from excessive IV iron isomaltoside administration, emphasizing the importance of vigilant monitoring of iron metabolism to prevent adverse outcomes.